This year, Juneau Mountain Rescue received the Mel
Nading Search and Rescue Award after a series of missions in the summer of 2022. The award recognizes “exemplary service of ASARA member volunteers performing search and rescue operations either on an individual or team level in difficult, dangerous, or complex situations while going above and beyond the call of duty associated with routine SAR missions.” JMR received the award for its execution of five rescue missions in Juneau, Alaska Between August 1st and August 5th. Four of the operations occurred within the course of 48 hours.
The first mission on August 1st required 15 responders, including a rope team, lasted 7 ½ hours and involved a hypothermic subject with known mental illness and drug abuse. The next mission occurred on August 4th with a 2115 callout for a lost hiker with a sprained ankle, with rescue teams and operations completing the mission at 0300 on August 5th while a weather system moved in. At 0810 on August 5th, JMR received another callout for an overdue hiker that had not returned from a hike at 4,000 feet and had been spotted on the ridge the evening of August 4th with no shirt and no water. The hiker was stranded on the Mt. Roberts ridge overnight during the weather system that
came in, which produced strong winds, heavy rain, and zero visibility.
While JMR was working the Mt. Roberts hiker, the
team received an additional mission request for 3 hikers who were lost in the storm and needed assistance at 3,400
feet on Mt. McGinnis. Both the Mt. Roberts and the Mt. McGinnis operations resolved around 1830 with the successful location and extraction of all subjects.
The extreme weather pattern continued through the day and night of August 5th. After debriefing the previous missions, JMR received a call-out request at 2335 to assist the United States Coast Guard with a stranded hunter on Chichagof Island. JMR operation leaders and a virtual planning team stayed up the rest of the night working on the
response, extraction and safety plan and assembled gear to support the insertion of two JMR team members into a potential multi-day operation to support the location and retrieval of the subject who was in an extremely remote location on Chichagof Island.
The strike team deployed with the USCG, who was ultimately able to hoist the subject from his location during a break in the weather. In total, JMR had 17 responders participate in these five missions, with many of those responders participating in back-to-back missions.
JMR was awarded the Mel Nading award a year later
in August 2023 for their efforts during those 48 hours. The team was heralded for their dedication and professionalism through the constant callouts and heavy weather Recent studies from outdoor industry analysts show that as much as 80% of outdoor activity categories showed growth in participation in 2022. Likewise, search and
rescue teams (mountain teams included) have seen a rise in activations across many of the more heavily trafficked outdoor areas in the United States. With the frequency of callouts and the potential for inadequate rest and recovery of responders, it is important to be aware of injuries that may happen to responders.
TRAINING:
The research that exists for search and rescue operations show that the majority of injuries actually occur in training situations. Trauma of varied quality makes up the majority of injuries suffered, and extrapolation from data in
other fields of recreation in similar environments show that lacerations/soft tissue injuries and orthopedic injuries (including dislocation, fractures, strains and sprains) are the most likely to be experienced. Traumatic head injuries, while not the most common outdoor injury pattern in general but with catastrophic consequences, should still be mitigated by proper personal protective equipment.
Training also has the potential to lead to complacency when few injuries have been encountered. This can be especially true when training repetitively in a familiar environment. Fostering a culture of diligence for safety even in training scenarios with a healthy understanding that not all safety concerns can ever be mitigated fully should be the ongoing goal.
FIELD RESPONSE: PREINCIDENT ARRIVAL
Around 6,500 accidents involving ambulances occur
every year in the US with about 60% happening while in emergency use. Utilizing lights and sirens to get to a scene only saves highly recognizable vehicles like ambulances
between 1.7 and 3.6 minutes of response time. With typical response time of several hours for many Mountain SAR teams, using lights and sirens and excessive vehicular speed does not seem to add significantly to the response time but does increase the likelihood of injury from accidents. Slow is smooth. Smooth is fast. Slow is fast.
FIELD RESPONSE: OPERATIONS
Operating in a new or rarely seen environment comes with additional layers of risk such as a lack of knowledge about terrain where more diligence in situational awareness may
be demanded in a more fatigued state. There are further injury patterns to be aware of that can be both debilitating and dangerous on field operations. Musculoskeletal and soft tissue trauma like lacerations still rank among the highest likely injuries in the back country for responders, and head trauma is still very much a consideration. Blister care knowledge and supplies become more apparently needed on call outs as there will be less familiar technical terrain and these events can last significantly longer than training scenarios putting the feet of responders at more risk. Additionally,
transportation injuries can certainly be a concern in the backcountry. Use of utility and all-terrain vehicles and even horseback operations provide ample opportunities for crush and rollover injuries. Working in areas of known wildfire potential should also prompt a
team to be ready to deal with burn patterns. even envenomation and animal attacks become possibilities, though still rare among injury patterns seen across the backcountry setting.
Animal encounters in general mandate at least an awareness level of how wildlife utilize the area in question and some of their seasonal movement patterns. The
potential for these meetings should also have planning in
the training arena, but a false sense of complacency even
in unfamiliar terrain for a team could make the concept
of wildlife awareness even more important. There may
be need to pack items like bear spray, as well as have a
higher alertness for venomous snakes depending on seasonality and terrain features. Stinging insects account for a number of encounters, especially in the Southeast, and anaphylaxis preparedness is a key.
Environmental exposure (heat, cold, wind, rain) can
lead to exposure problems such as hypo or hyperthermia.
These exposures, along with lack of hydration or nutrition,
can lead to fatigue which can compromise decision making
and eventually lead to injury. Proper nutrition, hydration
and exposure preparedness can help mitigate these problems. Having access to individual medical history including present medications and allergies is vitally important when a teammate is injured in the field. This can be as simple as having medical history info in an IFAK and also located on
cellphone along with emergency contacts. Knowing how to access a cellphones’ Emergency contacts and info is a skill every rescuer should have.
INDIVIDUAL FIRST AID KIT:
RECOMMENDATIONS
Taking into consideration that harm and injury can befall
a responder at any point in the response chain, it would
be prudent to adjust the first aid items carried by the
responder to further assist in mitigation of these harms.
There is some variation with environment and terrain, but
in general it is beneficial if each member of a response has
the proper equipment to assist in their own stabilization
and even rescue should it be necessary.
Usually, team members will have an idea of how much
they may need in terms of nutrition and hydration, and likely know their local terrain well enough to maintain proper attire and PPE such as ear and eye protection when needed and environmental protection from rain, wind, cold, heat, and low light situations. Addition of a lightweight bivy sack which could be modified into a thermal blanket, a chem light, small packets of energy food and electrolytes,In terms of personal first aid there should be a focus on most likely-to-occur patterns.
First and foremost, every
responder should always carry
their own prescription medications.
Likewise, injectable epinephrine has become quite common even in the non-medical personnel equipment list. Injectable epinephrine would be an item of recommendation as it is unlikely that any individual knows fully his or her allergy profile well enough to know they would
never have a reaction to anything they encountered.
Anaphylaxis is a critical illness with a high mortality potential and a relatively uncomplicated antidote.
Orthopedic equipment such as a folding reinforced splint (think SAM splint ® or similar) triangle bandage or
plan for improvised sling, and elastic athletic bandage
would be useful based on the most likely injuries to be
suffered from trauma in the backcountry. One should also
be able to control massive hemorrhage by including commercial tourniquet options as well as pressure bandage material, wound packing material, sturdy tape, and a cutting utensil. Practice applying these materials to oneself, and a partner is a paramount skillset.
Minor wound care options including assorted waterproof bandage material, blister care options, and over the counter options (if applicable based on medical history and physician consultation prior to operations) for minor pain can be useful. Chewable aspirin is also of high importance as medical based injury patterns do include cardiac considerations even in the backcountry responder setting.
If the capacity exists on a team
for drone inclusion, then delivery of additional equipment may be a skill to be practiced before needed on an actual event. Lastly, knowing where each responder’s personal first aid kit is on their person and having it clearly marked and at the ready will decrease time to care for a responder whether it be self-care or buddy-aided care.
*Atrium Wake Forest Health,
Department of Emergency Medicine; Appalachian Mountain Rescue Team,
Assistant Chief – North Carolina
